Aspiration Pneumonia caused by Povidone-iodine (Betadine) in Cleft Palate Patient

김석화,석효현,정의철,박지웅,최태현,Kim, Sukwha,Seok, Hyo Hyun,Jeong, Eui Cheol,Park, Ji Ung,Choi, Tae Hyun Korean Cleft Palate-Craniofacial Association 2013 Archives of Craniofacial Surgery Vol.14 No.1

Povidone-iodine (PVP-I, Betadine) has many advantages as a disinfectant solution for preoperative preparations, especially for oral surgery. It is widely used because of its low toxicity and excellent bactericidal effect. The authors report a case of pneumonia secondary due to the aspiration of PVP-I, which was used as an oral disinfectant. We present a case of aspiration pneumonia that resulted from the careless use of PVP-I during preoperative preparation. The patient was a 10-month-old female scheduled for elective surgery to correct a complete cleft of secondary palate. During the preparation of the oral cavity for that cleft palate patient, PVP-I was incidentally aspirated to the airway. The lung resistance was noted with positive pressure and pneumonic infiltration on chest radiograph was seen. The operation was postponed and the patient underwent respiratory care. Three months later, elective palatoplasty under general anesthesia was performed without complication. Based on the experiences of this case, the authors advise that throat-packing should be placed before oral preparation to prevent serious pulmonary complications.

Comparison of the 3D Digital Photogrammetry and Direct Anthropometry in Unilateral Cleft Lip Patients

석효현,권근용,백승학,최태현,김석화,Seok, Hyo Hyun,Kwon, Geun-Yong,Baek, Seung-Hak,Choi, Tae Hyun,Kim, Sukwha Korean Cleft Palate-Craniofacial Association 2013 Archives of Craniofacial Surgery Vol.14 No.1

Background: In cleft lip patients, the necessity of a thorough preoperative analysis of facial deformities before reconstruction is unquestioned. The surgical plan of cleft lip patient is based on the information gained from our preoperative anthropometric evaluation. A variety of commercially available three-dimensional (3D) surface imaging systems are currently introduced to us in plastic surgery for these use. However, few studies have been published on the soft tissue morphology of unrepaired cleft infants described by these 3D surface imaging systems. Methods: The purpose of this study is to determine the accuracy of facial anthropometric measurements obtained through digital 3D photogrammetry and to compare with direct anthropometry for measurement in unilateral cleft lip patients. We compared our patients with three measurements of dimension made on both sides: heminasal width, labial height, and transverse lip length. Results: The preoperative measurements were not significantly different in both side of labial height and left side of heminasal width. Statistically significant differences were found on both side of transverse lip length and right side of heminasal width. Although the half of preoperative measurements were significantly different, trends of results showed average results were comparable. Conclusion: This is the first study in Korea to simultaneously compare digital 3D photogrammetry with traditional direct anthropometry in unilateral cleft lip patients. We desire this study could contribute the methodological choice of the many researchers for proper surgical planning in cleft lip reconstruction field.

Analysis of alveolar molding effects in infants with bilateral cleft lip and palate when treated with pre-surgical naso-alveolar molding appliance

Dong-Seok Nahm(남동석),Won-Sik Yang(양원식),Seung-Hak Baek(백승학),Sukwha Kim(김석화) 대한치과교정학회 1999 대한치과교정학회지 Vol.29 No.6

Presurgical Naso-Alveolar Molding Appliance for Unilateral Cleft Lip and Palate

Seung-Hak Baek(백승학),Won-Sik Yang(양원식),Sukwha Kim(김석화) 대한치과교정학회 1998 대한치과교정학회지 Vol.28 No.6

표피수포증의 수부기형에 대한 교정술

김인건,김진환,오갑성,김석화 大韓成形外科學會 1991 Archives of Plastic Surgery Vol.18 No.6

열성 유전형 이영양성 표피수포증에서 생긴 심한 수부기형을 수술로 교정하여 좋은 결과를 얻었으며 이를 위해서는 수술전후 환자의 전처치(total care)와 질병에 대한 교육이 필요하며 수술로 표피고치를 장갑벗기듯이 조심스럽게 벗기면 쉽게 제거되고(epidermal degloving), 구축을 완전히 펴지도록 하며 피부이식술과 적절한 고정이 필요하다. 술후 장기간 부목을 착용시키고, 능동적 운동을 계속하며, 마찰로 물집이 생기지 않게 예방하는 조치를 게을리 하지 않아야 한다. Epidermolysis bullosa refers to a group of whose primary common feature is the formation of skin blisters following trivial trauma. Although any of dystrophic or scarring types of epidermolysis bullosa may produce hand deformities, the recessve type produces the most severe and characteristic hand deformity-adduction contracture of the thumb, volar contractures of the palm and digits, and a pseudosyndactyly in an epidermal cocoon. The advanced hand deformity needs surgical therapy and the understanding of the pathomechanics of the development of the hand deformity is essential for the effective treatment. The objective of the hand reconstruction is to reestablish elementary pinch and grasp by the release of adduction contracture of the thumb and the palmar contracture and resurfacing by skin graft. A patient with recessive dystrophic epidermolysis bullosa is described, who had serious hand disability. The surgical correction of the hand deformity, dressing with biobrane, and the appication of the splint improved hand function.

반안면왜소증에서 점진적 신연술을 이용한 하악골 연장

김석화 大韓成形外科學會 1998 Archives of Plastic Surgery Vol.25 No.4

Gradual distraction on living tissues creates stress that stimulates growth and regeneration. Timing and rate of distraction are one of the major factors affecting callus distraction. Slow rate of distraction often led to premature consolidation of the lengthening bone, while rapid rate of distraction often resulted in undesirable change within lengthening bone. Since Dr. McCarthy reported the successful lengthening of mandible in hemifacial microsomia, most of craniofacial bone lengthening has been done at a rate of 1.0 ㎜ per day. The purpose of this study is to present my experience of rapid and multidirectional distraction of mandible in hemifacial microsomia. I have performed distraction osteogenesis of mandible in 33 patients of hemifacial microsomia with an age of 2-9 years from November, 1995 to October 1997. A complete osteotomy was made at the angle of mandible posterior border of the ramus proximal to the osteotomy and two threaded wires were inserted aling the lower border of the body distal to the osteotomy. Long PennigMinifixator(Orthofix, Bussolengo, Italy) maintained the mandible in fixation for 4 days. Following this period, the device was lingthened serially 1 ㎜ every 12 hours by turning the nut. After the period of active lingthening was complicated, the mandible was maintained in external fixation until the radiological consolidation of the bone was confirmed. According to a study protocol, photographs, cephalograms(lateral and frontal), and panoramic view of mandible were obtained preoperatively, just before the active lengthening, at the time of removal of the device, and at 6 months intervals thereafter. The amount of vertical distraction along the posterior border of the ramus was from 19 to 32 ㎜ and horizontal distraction along the lower border of the body was from 3 to 18 ㎜. The total amount of distraction was from 25 to 47 ㎜. The period of rapid distraction was from 13 to 27 days. Following the period of rapid distraction the mandible was maintained in external fixation for an average of 8.5 weeks(ranging from 7 to 11 weeks). There was no preoperative complications, and the length of clinical follow-up tangles from 3 to 26 months. Early reconstruction with minimal morbidity of rapid and multidirectional mandibular distraction in the hemidacial microsomia was successful without relapse. Orthodontic treatment can begin as soon as possible after gradual distraction in order to establish normal dental occlusion.

Furlow 구개성형술을 이용한 점막하 구개열의 교정

김석화,김지혁,김진환,이윤호 大韓成形外科學會 2000 Archives of Plastic Surgery Vol.27 No.2

Furlow's palatoplasty has been used as the primary treatment for cleft palate. From 1991 to 1999, 24 submucous cleft palate patients underwent Furlow's palatoplasty. The follow-up period was 3 months to 8 years(mean 24 months). Patients were selected after a thorough study for velopharyngeal insufficiency including intraoral examination, speech assessment, digital subtraction radiography(DSR). Postoperatively velopharyngeal function was reevaluated with speech assessment and digital subtraction radiography in the 7 cooperative patients. Speech parameters including hypernasality, nasal emission, and Allison scale were improved after surgery. Digital subtraction radiography provided the value of velopharyngeal gap and the degree of the motion of lateral pharyngeal wall, both of which were improved after surgery. Furlow's palatoplasty has advantage such as no impairment of nasopharyngeal physiology, no harmful effect on the hard palate and the realignment of the levator muscle which plays important role on the movement of the soft palate. The results show that a Furlow's palatoplasty can satisfactorily correct velopharyngeal insufficiency in carefully selected submucous cleft palate patients.

어린이에게 완전 절단된 음경의 미세 수술학적 재접합 : A CASE REPORT

김광명,백재승,김석화,최황,이종국,방사익 大韓成形外科學會 1993 Archives of Plastic Surgery Vol.20 No.2

Amputation of the penis is rare. It may occur by self-mutilation in psychotics, iatrogenically at the time of surgery, or as the result of industrial accidents or criminal acts. Aside from its sexual aspect the loss of the phallus incurs a definite handicap in body image and voiding. Before the era of microvascular surgery, the replantation of the amputated penis was done without vascular repair. The fact that the penile replantation is possible without the microvascular repair is a testament to the unique anatomy of the penile vasculature. But the most common complications after replantation without vessel repair were distal skin necrosis, fistula formation, and stricture of urethra. Among these complications, skin necrosis was most common, Microvascular repair avoids extensive skin necrosis because it establishes immediately subcutaneous circulation rather than relying on blood flow across corpora cavernosa and subcutaneous tissue, as occurs when no attempt at vascular anastomosis is made. Cohen(1977)and Tamai(1977)were the first to achieve successful replantation of the penis using microsurgical techniques. Their works were followed by many further cases of microsurgically treated patients, but they were almost all in adults and amputations at the middle of penile shaft. We report a successful microsurgical repair following iatrogenic amputation at the subcoronal area of the penis in a boy who is 11 years old.

구개열과 구순열을 동반한 선천성 치조유착 증후군

김석화,반준섭 大韓成形外科學會 1998 Archives of Plastic Surgery Vol.25 No.1

Alveolar synechia or syngnathia is a rare anomaly showing soft tissue or bony adhesions between the alveolar ridges of maxilla and mandible. In our review of the world literature, we have identified 68 reports of alvelolar synechia. Most cases describe cleft palate and the term cleft palate and congenital alveolar synechia syndrome was coined by Verdi and 0'neal(1983). Additional anomalies such as cleft lip, micrognathia, microglossia, lower lip pits, ankyloblepharon, and limb anomalies are associated. Related syndromes may include popliteal pterygium syndrome, van der Woude syndrome, and orofaciodigital syndrome. We present a child with congenital alveolar synechia and left unilateral complete cleft lip and palate. The child had difficulty in mouth opening with a maximal anterior jaw opening of 4 mm. The fibrous synechia was resected at the age of 4 months. On dividing the fibrous band, the jaws were distracted to an opening of only 7 mm using finger dilatation. However, the maximal anterior jaw opening by passive dilatation had increased to 19.0 mm after 2 months and up to 23.1 mm after 6 months by stretching exercise of the mandible, so the child could open his mouth successfully.

Presurgical Naso-Alveolar Molding Appliance for Unilateral Cleft Lip and Palate

Baek, Seung-Hak,Yang, Won-Sik,Kim, Sukwha 대한치과교정학회 1998 대한치과교정학회지 Vol.28 No.6

본 연구의 목적은 1)편측성 순구개열 신생아 환자에 대한 술전 비치조 정형장치(PNAM)치료를 소개하고 2) 이 장치의 치조골 정형 효과를 평가하는 것이다. 서울대학교 병원 교정과에 내원하여 PNAM장치를 사용하여 치료받은 4명의 편측성 순구개열 호나자(남자 3명, 여자 1명, 평균 초진연령: 23.2일)을 대상으로 하였으며, 치조골에서 대분절과 소분절 파열부간의 평균거리는 8.27mm였고 치조골 정형치료의 평균기간은 9.7주였다. 초진시(Ti)와 성공적인 치조골 정형술이 이루어진 시기(T2)에 이들 환자의 인상을 채득하여 모형을 제작한 후, 사진촬영과 digital caliper를 사용하여 7개의 길이 항목과 5개의 각도항목을 계측하였다. SPSS win. ver 7.5프로그램을 사용하여 통계처리 하였고, 평균치의 차이를 비교하기 위하여 paired t-test를 사용하였다. 1. 신생아 치조골 후방부는 치조골 정형술을 시행하는 동안 안정된 구조물이었다. 2. 치조골 정형술에 의하여 대분절의 전방 성장이 억제되었다. 3. 치조골 정형술에 의한 파열부의 패쇄는 주로 대분절 전방부의 내측과 후방 굴곡 및 소분절 전체의 외측 굴곡에 의한 것이었다. The goals of this study were to present presurgical naso-alveolar molding(PNAM) appliance in unilaterla cleft lip and palate treatment and to evaluate the effects of PNAM appliance on alveolar molding. Samples were consisted of 4 unilateral cleft lip and palate infants(3 males and 1 female, mean age=23.2 days after birth) who were treated with PNAM appliances in Department of Orthodontics, Seoul National University Dental Hospital. Average alveolar cleft gap between the greater and lesser segment was 8.27 mm and average duration of alveolar molding treatment was 9.7 weeks. These patients' models were obtained at initial visit(T1) and after successful alveolar molding(T2). Seven linear and five angular variables were measured by using photometry and digital caliper. All statistical analyses were performed by SPSS win ver. 7.5 program. Paired t-test was used to compare the mean values. 1. The posterior part of alveolar segments are the stable structures during alveolar molding treatment period in infants. 2. Forward growth of th greater segment may be hindered by the action of alveolar molding. 3. The closure of cleft gap during alveolar molding were usually due to inward and backward bending of the anterior part of the greater segment and outward bending of the whole lesser segment.